Journal of Minimal Access Surgery (Jan 2005)
Does laparoscopic Nissen fundoplication prevent the progression of Barrett′s oesophagus? Is the length of Barrett′s a factor?
Abstract
INTRODUCTION: Recent studies have suggested that both laparoscopic and open anti-reflux surgery may produce regression of Barrett′s mucosa. MATERIAL AND METHODS; We reviewed 21 patients (13M: 8F, mean age 46.7±3.18 years) with documented Gastroesophageal Reflux Disease (GERD) and Non-dysplastic Barrett′s esophagus (15 patients ?3 cm segment, 6 patients < 3 cm segment) on long term proton pump inhibitor therapy who underwent laparoscopic Nissen fundoplication (LNF) between 1993 and 2000. All patients had undergone pre and yearly postoperative upper GI endoscopy with 4 quadrant biopsies every 2 cm. All patients also underwent pre- and 6 months postoperative 24-hr pH study, esophageal manometry, SF36, and GERD symptom score. The mean duration of GERD symptoms was 8.4±1.54 years pre-operative. The mean follow-up after surgery was 39±6.32 months. RESULTS: Postoperatively, there was significant improvement in reflux symptom score (37.5 ± 3.98 points versus 8.7 ± 2.46 points, P = 0.0001), % acid reflux in 24 hr (26.5 ± 3.91% versus 2.1 ± 0.84%, P< 0.0001) and an increase in lower esophageal sphincter pressure (3.71 ± 1.08 mmHg versus 12.29 ± 1.34 mmHg, P = 0.0053). Complete or partial regression of Barrett′s mucosa occurred in 9 patients. All patients with complete regression had <4 cm segment of Barrett′s. Progression or cancer transformation was not observed in any of the patients. CONCLUSION: LNF in patients with Barrett′s oesophagus results in significant control of GERD symptoms. LNF can prevent progression of Barrett′s oesophagus and in patients with Barrett′s <4 cm may lead to complete regression.
